Your Right to Know

A proposal issued this week by an advisory council appointed by lawmakers recommends 20 measures
for determining how well the facilities look after their patients.

The measures include allowing residents to choose when they go to sleep and get up in the
morning, and giving them the opportunity to take a bath or shower whenever they like. They also
would require that bathrooms be wheelchair-accessible and would limit the use of building-wide
paging systems to emergencies.

The measures also seek to reduce bedsores and urinary-tract infections, limit turnover of staff
members and improve family satisfaction.

Legislators are expected to vote on the proposed standards this year.

If approved, they will be used as part of a new Medicaid incentive program. Nursing homes
meeting a quarter or more of the performance measures would be paid a higher rate for the care they
provide patients on Medicaid, the tax-funded health-care program for the poor and disabled.

Bonnie Kantor-Burman, director of the Ohio Department of Aging and a member of the advisory
panel, said the goal is to provide individualized care that will improve the lives and health of
nursing-home residents.

Many of the recommendations, she said, aim to give patients more choices and control over their
lives. For instance, instead of health aides awakening residents at set times and meals being
served at set times, residents should get up when they are ready and eat when they are hungry. She
said that would make patients happier, limit staff turnover and reduce costs.

Kantor-Burman said the panel focused on goals that are relatively inexpensive to implement and
have been shown to yield benefits for residents, nursing-home staffs or both.

“This is not a time to expect large capital outlays from nursing homes,” she said.

The recently passed state budget slashed payments to the homes to help close a massive
shortfall. The average daily rate dropped on July 1 to $167.25 per patient, from $177.53.

In the next fiscal year, which begins on July 1, 2012, the rate will bump up to $168.84 for
homes meeting quality benchmarks. Those failing to meet the goals will be paid $152.40.

The budget also required that a greater share of the payments — 61 percent — be spent on direct
care.

The 15-member advisory committee was made up of advocates for the elderly, representatives of
nursing homes, state officials and legislators.

“The goal of the method is to create a system that rewards performance on specific quality
measures and gives all facilities a fair opportunity to earn the full quality incentive payment,”
the committee wrote in its report.

Under the committee’s recommendations, a facility would be required to meet five measures to
receive the full quality payment, which is $16.44 in the 2013 fiscal year. The state budget assumes
that every nursing home will earn the full payment. If some do not, the undistributed funds will be
shared among those meeting the benchmarks.

Pete Van Runkle, executive director of the Ohio Health Care Association, said incentives will “
be very helpful in getting (nursing homes) focused on these issues.”

He predicted that most of the more than 900 nursing homes in Ohio will meet the five goals
needed to qualify for bonus payments.

But some goals will take time, such as the one that at least half of a nursing home’s
Medicaid-certified beds be in private rooms. Van Runkle estimated that about 20 percent of homes
meet that benchmark.